roz, thanx for the clarification. You are entirely correct on your point of "employed " (kind of a funny term as if the rest are unemployed.. :
..I am one of those and it always cracks me up) physicians, I should have been more clear in that I was referring to those in private practice or independent group settings. The rest do have a choice and are being forced into some unpleasant ones.
So many physicians that can no longer afford to keep their practices/group practices viable after even 20 or more years in practice are now working for hospitals, HMOS, the VA etc. They do in fact take all comers as defined by their employers. Intersting trend, and while likely to continue, it is not a solution to access by any means.
Your point about practices that don't file insurance and operate independently is a good one also, and in some cases the only way fiscally to continue practice. And while it does free one from the choking rules and constant battles for reimbursement, it still leaves the question of who will take care those with Medicaid, Medicare, and substandard insurance or no real financial means to otherwise afford medicines and care for ongoing conditions like diabetes, hypertension, seizures, heart disease, etc. These are a great majority of people that end up in the E.R. and subsequently hospitalized with conditions that likely could have been prevented with out patient access to maintenance care and medicines.
Your insight into the difficulties of billing, and the costs to the physician of dedicating
at least employee to the task of trying to fight for the few dollars of reimbursement is also right on point but missed by most people entirely.
We really do need a "single payer" type system. The more accurate term is national health insurance. The term "socialized medicine" is used to politicize the issue and polarize people by those more concerned with their own political leanings than addressing the problems.
Make no mistake..we are not talking about "giving away more for free" nor is it a question of "where does it all stop?". When we are dealing with an issue that now em compasses 16% of our gross domestic product and affects the survival, viability, and advancement of our country, its time to take a hard long look. We already spend vast sums on a system rife with inefficiency and several different fractured programs with different rules and oversight. It is time to reexamine what we have and restructure it into something more efficient and humane. It is being done by essentially every other industrialized nation except the U.S. Until we are ready to do so the problems of access for seniors and those working people that fall through the cracks will escalate rapidly When these people are sick enough to end up in the hospital they will then get band aid treatment and be released to repeat the cycle again. its really maddening..a ridiculous cycle.